Ciguatera fish poisoning is the most common foodborne illness related
to fin fish consumption and is endemic throughout the Caribbean and In
do-Pacific regions. The clinical picture is characterized by a variety
of gastrointestinal, neurologic and, occasionally, cardiovascular sym
ptoms. Patients with bradycardia and/or hypotension may require urgent
care. Neurologic symptoms tend to be the most distinctive and endurin
g and include sensory changes such as generalized pruritus, circumoral
numbness and reversal of hot and cold sensation. Intravenous mannitol
has evolved as a unique remedy for patients with acute poisoning, but
management of chronic symptoms continues to be problematic. Though di
fficult to implement, preventive strategies remain the best defense.